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General NPI Number Information
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NPI Number | 1598996712
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Entity Type | Individual
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Provider Name | IVANA LUISA LABUCKAS M.A., LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 3756 SANTA ROSALIA DR STE 424
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City | LOS ANGELES
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State | CA
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Zip | 90008-3614
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Country | US
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Telephone | 310-266-2946
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Fax | 323-596-3473
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Provider Business Mailing Address
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Address Line | 3401 S BENTLEY AVE APT 204
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City | LOS ANGELES
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State | CA
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Zip | 90034-2063
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Country | US
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Telephone | 310-266-2946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT93659
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License Number State | CA
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